Enhancing the Design and Evaluation of Care Delivery for Patients on Oral Anticancer Agents
Authors: Benyam Muluneh
Journal: Journal of the National Comprehensive Cancer Network (2022)

O ral anticancer agents (OAAs) are now the mainstay of treatment in several cancer types.Although OAAs such as chlorambucil and methotrexate have been in use since the 1970s, widespread and continuous use of OAAs did not become common in cancer care until the approval of imatinib by the United States FDA in 2001.In comparison to the first decade of the 21st century, the second decade has seen an explosion in the approval of OAAs. 1 Although the rate of approvals of OAAs continues to increase, the safe and equitable delivery of cancer care in the context of OAAs has lagged.Medication nonadherence, the high cost of OAAs, unique patterns of adverse events, and the need to use mail-order specialty pharmacies all present unique challenges for cancer centers and patients. 2As cancer centers work to design and implement programs to optimize the use of OAAs in clinical practice, there is also a need to evaluate the extent to which these programs are successful.In this issue, Blinder et al 3 report on their study to assess the feasibility of ASCO's Quality Oncology Practice Initiative (QOPI) program in addressing the need for OAA-specific evaluation tools.ASCO's QOPI program was developed in 2013 to offer cancer centers external certification if they demonstrated safe and high-quality care delivery on a prespecified list of measures. 4QOPI measures were largely based on the 2013 and 2016 Chemotherapy Administration Safety Standards by ASCO and the Oncology Nursing Society (ONS). 5,6Although these standards largely focus on chemotherapy preparation and administration in infusion centers, efforts have been made to include and adapt these standards and apply them to patient self-administered OAAs.Blinder et al 3 selected 9 OAA-relevant measures across 3 domains: chemotherapy plan documentation (dose, administration schedule, indications); treatment education (prior to start day, missed dose instructions, toxicities, clinic contact instructions); adherence monitoring; and documentation of height/weight/body surface area.After reviewing data from 192 cancer centers (50 QOPI certified; 142 not certified) that had submitted patient data into the ASCO QOPI database, the study authors found that, for the most part, certification did not predict success on these OAA-specific measures, including for adherence assessment (odds ratio, 2.14; 95% CI, 0.71-6.48).A trend towards significance was seen in certified centers being more likely to provide clinic contact information for patients on OAAs compared with noncertified centers (odds ratio, 4.87; 95% CI, 1.00-24.00).As the wide confidence intervals indicate, the data showed large variability: median performances on individual QOPI measures across cancer centers ranged from 44% to 100%. 3he authors concluded that the wide variability in performance across the QOPI measures-and the lack of correlation between QOPI certification and performance on OAA-specific measures-present a clear gap. 3 The wide variability in performance (even among certified centers) may suggest varying degrees of application of the broader QOPI standards to OAAs.Because the QOPI measures were developed using a parenteral chemotherapy framework, it is plausible that application of the measures to OAAs is an afterthought.Even with more recent versions of the standards incorporating